ACAH Membership Application

First Name (required)

Last Name (required)

Gender
---MaleFemale

Email (required)

Phone (required)

Address (required)

State (required)
---Australian Capital TerritoryNew South WalesNew ZealandNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia

Post Code (required)

Current Position Held (required)

Areas of Interest

Membership Category
---Salary more than $100,000 - $300 paSalary less than$100,000 - $150 paOverseas membership $100 paRetired membership $100 paStudents - free (evidence of current enrolment must be provided with application

AHPRA Registration Number

If not AHPRA registration, upload copy of degree for students, upload current enrolment transcript

Upload brief CV & professional statement

Please check the following:

I HAVE ATTACHED A BRIEF (1 PAGE) CV INCLUDING DETAILS OF MY CURRENT EMPLOYMENTI HAVE ATTACHED A BRIEF PROFESSIONAL STATEMENT IN RELATION TO MY WORK WITH NEWBORNS, CHILDREN AND/OR ADOLESCENTS

THE ACADEMY OF CHILD & ADOLESCENT HEALTH MAINTAINS A DIRECTORY OF MEMBERS WHICH IS AVAILABLE FOR VIEWING ONLY BY OTHER MEMBERS ON REQUEST. THIS IS A LEGAL REQUIREMENT. IN SUBMITTING AN APPLICATION YOU ARE AGREEING TO BE PLACED ON THE MEMBERSHIP ROLL. DETAILS OF ACAH PRIVACY STATEMENT & ACAH CONSTITUTION ARE AVAILABLE AT WWW.ACAH.ORG.AU CHECK THE FOLLOWING BEFORE SUBMITTING:

I CONFIRM THAT I HAVE READ THE CONSTITUTION OF THE ACADEMY OF CHILD AND ADOLESCENT HEALTH (ACAH) DATED DECEMBER 2016 AND THAT, AS A MEMBER OF ACAH, I AGREE TO BE BOUND BY THAT CONSTITUTION AND ANY OF ITS RELATED BY-LAWS WHICH MAY APPLY FROM TIME TO TIME.I UNDERSTAND THAT ACAH IS A NOT-FOR-PROFIT COMPANY LIMITED BY GUARANTEE AND THAT MY GUARANTEE IS LIMITED TO TWENTY DOLLARS (AUD $20.00).I CERTIFY THAT I MEET THE ELIGIBILITY CRITERIA FOR THE MEMBERSHIP CATEGORY APPLIED FOR ON THIS FORM AND THAT I WILL IMMEDIATELY ADVISE ACAH OF ANY CHANGE IN ELIGIBILITY.I HEREBY AUTHORISE MY NAME TO BE PLACED IN THE REGISTER OF MEMBERS.

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